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WALGREEN CO.
FQHCLA302 Prohealth Rural Health Services, Inc
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Covered Entity Details
Entity Name
Prohealth Rural Health Services, Inc
Subdivision Name
*
Type
Health Center Program Look-Alike
340B ID
FQHCLA302
Entity Address
1325 W. Main Street
Franklin, TN 37064-3786
Grant Number
LALCS00061
Participating Start Date
10/1/2012
Last Recertification Date
2/9/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17830
801 N MAIN ST
MOUNT PLEASANT, TN 38474-1017
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ray White, President
(615) 591-4750
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2018
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